Oh, my aching back

  It can originate in the muscles, nerves, bones, joints or other structures in the spine and can occur in people of all ages and genders, especially the elderly. 

There are many treatment options, the ultimate of which is surgery and which is often only considered after all other treatments have failed to provide relief.

Patients have traditionally tended to be scared of surgery as it was a big issue and carried severe risks, including treatment failure and paralysis. However, thanks to continuously developing medical technology and increasingly experienced doctors, spinal surgery is not as frightening as it used to be. 

Options for surgery vary, depending on the type of disease or injury and the skill of the doctors. These options include conventional surgery and minimally invasive surgery, the latter of which aims to minimise the effects on the body’s tissues. 

However, common problems following any surgical approach include failed back surgery syndrome, which can be caused by the surgery itself, post-surgical care, or the patient’s lifestyle, including a lack of exercise, over-exercise, or heavy work too soon after the surgery. It also depends on the type of surgery. In some cases, the back pain lingers long after the surgery. 

Some patients experience adjacent segment pathology or pain in the adjacent bone. For example, following successful surgery of the 3rd and 4th vertebrae, the pain returns, causing the patient to think that the surgery was unsuccessful. In fact, the pain is caused by a bone adjacent to the ones that have been successfully treated. The degeneration may vary from person to person and can be fast or slow.

 In some cases, the reason why the doctor did not treat the adjacent vertebrae in the previous surgery is that it was still in good condition at that time. 

A case such as this may lead to chronic pain in the future, causing patients to suffer physically and mentally. Repeated visits to the doctors do not help and many patients try to find other ways to reduce the pain. Some patients will require repeated surgeries in the same spot, causing great concern both for them and their families. 

The surgical difficulty depends on the results of the patient’s evaluation, from which doctors have to locate the root cause of the continued pain. As part of this process, an in-depth study of the first surgery is conducted to determine if there has been any damage to the nervous system. 

If the cause is related to muscles and tendons, then surgery is likely to bring about a good result. Many cases of failed back surgery syndrome tend to fall into this category. 

If the cause is related to the nervous system, then the doctors will see if the damage is partial or permanent. If the damage is partial, it is possible to treat and improve the nervous system. 

The team of doctors talks to each patient to gather as much information as possible in order to establish the right diagnosis and formulate an effective treatment plan. Keeping your treatment history updated with full details is very beneficial and this will help the doctor provide treatment more quickly. 

The age of a patient is not an obstruction to the treatment of spine-related conditions. It all depends on the strength of the patient. The individual course of treatment to be followed is determined in accordance with the disease or injury and the condition of the patient’s body. In some cases, patients do not need surgery because physical therapy is sufficient for them to live a normal life. However, this option depends on the condition of the body and the mental state of the patient. 

 

 

 

Professor Prakit Tienboon, MD is an Orthopaedic Spine surgeon at

Samitivej Srinakarin Hospital. For an appointment, call the Revision Spine Centre at (02) 378 9000.